نوع مقاله: مقاله مروری

نویسندگان

1 گروه داروسازی بالینی، دانشکده داروسازی، دانشگاه علوم پزشکی شیراز.

2 دانشجوی دکترای تخصصی داروسازی بالینی، گروه داروسازی بالینی دانشکده داروسازی، دانشگاه علوم پزشکی شیراز، شیراز، ایران

چکیده

فیبریلاسیون دهلیزی، یکی از شایع‏ترین آریتمی‏ها در بالین است که شانس بروز حوادث ایسکمیک (ischemic) و عوارض متعاقب آن از جمله نارسایی قلبی، سکته قلبی، دمانس و مرگ ناگهانی قلبی را بالا برده و به طور کلی با افزایش میزان از کار افتادگی و مرگ و میر در بیماران همراه است. کاهش میزان بروز سکته و حوادث ایسکمیک در این بیماران، با استفاده از داروهای ضد انعقاد خوراکی صورت می‏گیرد. این داروها به دو دسته کلی شامل آنتاگونیست خوراکی ویتامین K (وارفارین) و داروهای ضد انعقاد خوراکی غیر آنتاگونیست ویتامین K هستند که دسته دوم خود به دو زیر شاخه‏ی مهار کننده‏های مستقیم فاکتور انعقادی 10 فعال (Xa) و مهارکننده‏های مستقیم فاکتور انعقادی 2فعال (IIa) تقسیم می‏شود. هر دو دسته اصلی دارویی دارای کارایی و ایمنی اثبات شده در پیشگیری از بروز حوادث ایسکمیک در بیماران فیبریلاسیون دهلیزی هستند. اما، امروزه با افزایش میزان شیوع و بروز بیماری، انتخاب داروی ضد انعقاد خوراکی مناسب، با توجه به شرایط و عوامل تهدید کننده خاص در هر بیمار، بعضا می‏تواند چالش برانگیز باشد. این مقاله مروری، با هدف بررسی کارآیی و ایمنی داروهای ضد انعقاد خوراکی در بیماران مبتلا به فیبریلاسیون دهلیزی در شرایط پیچیده، گردآوری شده است. در نهایت مروری نیز بر آنتی‏دوت‏های جدید ترکیبات ضد انعقاد خوراکی غیر آنتاگونیست ویتامین K، برای مهار خون‏ریزی در شرایط مسمومیت و یا نیاز بیمار به جراحی‏های اورژانسی، انجام شده است.

کلیدواژه‌ها

عنوان مقاله [English]

Comparison of Different Oral Anticoagulants Safety and Efficacy for Stroke Prevention in Atrial Fibrillation with Complicated Situations

نویسندگان [English]

  • Afsaneh Vazin 1
  • Bahareh Forouzani Haghighi 2

1 Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences.

2 PhD Candidate in Clinical Pharmacy, Department of Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran

چکیده [English]

Atrial Fibrillation (AF) is one of the most common arrhythmias that expose patients to thromboembolic events and hemodynamic instabilities. These events increase the risk of developing heart failure, myocardial infarction, sudden cardiac death, and dementia that eventually increase the rate of mortality in patients. The use of anticoagulants can prevent the mentioned severe adverse events. Two commonly used oral anticoagulant groups in AF patients are vitamin K antagonists (warfarin) and non-vitamin K oral antagonists (NOACs) that consist of direct factor Xa inhibitors and direct factor IIa inhibitors. Previous research proved the efficacy of both groups in reducing ischemic events in AF patients. In this review article, we were to evaluate and compare the safety and efficacy of these agents in reducing ischemic and thromboembolic events in AF patients with complicated risk factors such as chronic kidney disease, prosthetic heart valve, history of previous intracranial hemorrhage, etc. Finally, the reversal agents of these anticoagulants have been reviewed in case of severe bleeding, intoxication, and the urgent need for emergency surgery.

کلیدواژه‌ها [English]

  • Atrial Fibrillation
  • Anticoagulant
  • Stroke
  • Bleeding
  • Thrombosis

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